Pertussis (Whooping cough)
FactSheet For Parents and Caregivers
What is pertussis?
Pertussis, commonly known as whooping cough, is a
highly infectious bacterial infection spread by coughing and
sneezing. It causes severe bouts of coughing, which may be
accompanied by vomiting and a whooping sound. Pertussis
can last up to 3 months and is sometimes referred to as the
100 day cough. The symptoms are more obvious in children,
as adults and infants are less like to whoop.1
What are the symptoms of pertussis?
Pertussis can be divided into three stages:
The initial stage following the incubation stage, called the
catarrhal stage is the most infectious. It lasts 1-2 weeks and
can include a runny nose, sneezing, slight fever, and a mild
irritating cough.
The second stage or paroxysmal stage usually lasts 1-6
weeks, but can persist for up to 10 weeks. A paroxysm is
a spasm of coughing followed by a big breath in or high
pitched whoop. Infants and young children often appear
very ill, and may turn blue and vomit with coughing bouts.
Infants and adults generally do not have the characteristic
whoop sound.
The convalescent stage may last for months. Although the
cough eventually disappears after several weeks, coughing
fits may recur whenever the patient suffers any subsequent
respiratory infection.
How serious is pertussis?
Around 7 out of 10 babies who catch pertussis before the
age of 6 months require hospitalisation and 1 in 30 of those
hospitalised die from pertussis infection. Severe coughing can
temporarily stop the oxygen supply to the brain (hypoxia).
In around 2 per 1000 children pertussis leads to permanent
brain damage, paralysis, deafness or blindness. Secondary
infections such as pneumonia and ear infections can occur.
The disease is usually milder in adolescents and adults,
consisting of a persistent cough similar to that found in other
upper respiratory infections. Some adults experience rib
fracture from violent coughing.1 Both hospitalisations and
deaths are likely to be under-estimated in adults due to the
lack of the whooping sound.
How do you catch pertussis?
Pertussis is highly contagious and is spread by coughing and
sneezing. It infects around 90% of non-immune household
contacts1 and 50 to 80% of non-immune school contacts.
Many babies catch it from their older siblings or parents -
often before they are old enough to be fully vaccinated.2
How common is pertussis?
New Zealand has epidemics every 3-4 years1 with several
thousand cases (mostly young children) reported in each
epidemic. Adolescent and adult pertussis often goes
unrecognised and is often under reported. Up to a third of
adolescents and young adults with a persistent cough have
evidence of recent pertussis infection.3-5
Who is most at risk from pertussis?
Those most at risk of serious disease are infants under one
year of age. About 90% of whooping cough related deaths
occur in infants infected in their first month of life. Infants
who do not receive doses of pertussis containing vaccine
at the scheduled times of 6 weeks, 3 months, and 5 months
have up to a five-fold increased risk of being hospitalised with
pertussis.3
How do you prevent pertussis?
On-time immunisations for infants at 6 weeks, 3 months
and 5 months in addition to children receiving boosters at 4
years and 11 years is the best prevention.2 There appears to be
very little maternal protection passed to the newborn against
pertussis through the placenta or breast milk.1,4 Antibiotics
(usually erythromycin) do not cure pertussis but are given to
reduce the spread of infection to others. All cases of pertussis
should be excluded from early childhood services, school, or
community gatherings until they are well enough to attend
and have either received five days of antibiotics or three
weeks have elapsed since the onset of coughing spasms.
Vaccines and vaccination against pertussis.
Whole cell pertussis vaccines were initially developed in
the 1940s. These were replaced by newer acellular pertussis
vaccines (to New Zealand in 2000)1,5 because there are fewer
and less severe reactions to the acellular vaccine than to the
whole cell pertussis vaccine.6,7
Pertussis vaccine is given as a single injection in combination
with the other vaccines: diphtheria, tetanus, polio, hepatitis B
and Hib at 6 weeks, 3 months and 5 months.5
A booster dose of pertussis is given at 4 years old in
combination with diphtheria, tetanus and a final dose of
polio. Due to the short lasting immunity to pertussis, a
booster dose is also given at age 11 in combination with
diphtheria and tetanus. Some countries routinely immunise
adults with a dose of pertussis containing vaccine to further
reduce the spread to infants.8-10 Adult vaccines against
pertussis are available and recommended in New Zealand.
How effective are the vaccines?
Three doses of vaccine during infancy will protect about 80%
of recipients from infection through to about 4-6 years of
age.11,12 Pertussis immunity wanes over time following both
natural infection and vaccination.13 Studies on additional
booster doses given during adolescence and adulthood show
they significantly reduce the rates of disease in these groups.2
Re-infection may occur as a persistent cough, rather than
typical pertussis. Booster doses are thought to last at least
5 years and may extend longer.10 However, the duration of
immunity of pertussis booster doses have not been formally
established.1,13
Who should get the vaccine?
The vaccine is funded for all infants aged 6 weeks, 3 months
and 5 months, with booster doses given to children at 4 and
11 years. Immunisation is recommended and sometimes
funded, for health professionals working closely with infants
and staff of early childhood services. Other adults who wish
to receive a booster vaccine should be encouraged to do so.2,14
Who should not get the vaccine?
Anyone who has had an anaphylactic reaction to the
vaccine or any component of the vaccine should not be
vaccinated, nor should anyone with a history of unexplained
Pertussis (Whooping cough)
FactSheet For Parents and Caregivers
encephalopathy (inflammation of the brain) within 7 days of
a pertussis vaccination. Talk with your doctor or vaccinator
for more in depth information.
Who should seek more advice before having the
vaccine?
Immunisation in infants with a developmental regressing
neurological condition or uncontrolled seizures should be
postponed until the condition is stabilised.6 These conditions
are rare and can be discussed with your childs specialist to
determine on a case by case basis what is best for your child.
Do you need all the doses?
As infants are most severely at risk3,4,15 it is important to start
the immunisation at 6 weeks of age and complete the first 3
doses as well as booster doses on time. Immunity from both
the disease and the vaccine wanes over time (immunity from
vaccine lasts about 4-6 years) so booster doses are needed
for longer term protection, and to minimise the spread
particularly to vulnerable babies.2,14 As pertussis is a very
contagious disease that is difficult to eliminate and due to the
limited duration of immunity, it is important to have all the
doses on time, every time.
How safe is the vaccine?
Reactions at the injection site such as redness or swelling
are common occurring 10-20% of the time. Fever is noted
in about 25% of those vaccinated. Extensive swelling at the
injection site can occur with booster doses; however it is
not associated with pain and fully resolves after a few days.
(This is most likely caused by the diphtheria component.)
Occasionally, very rare reactions such as seizures or persistent
crying have been known to occur. Generally, the pertussis
containing vaccines are well tolerated.1,6,7,16

Disease Effects of disease Side effects of the vaccine

A highly contagious bacterial 1-3 per 1000 risk of permanent Pain or redness (2-7%) at injection site
infection which causes neurological damage for patients Fever (25%)
a whooping cough and with paroxysmal cough.
Large painless swelling at injection site (1-8%)
vomiting. Case fatality of 3 or 4 per 100 in
hospitalised infants younger than Very rare adverse events:
6 months. Seizures (<7/100,000)
Persistent crying (<5/10,000)
Hypotonic Hyporesponsive Episode
(<3/100,000)
Anaphylaxis (<1/1,000,000)
Vaccines are prescription medicines. Talk to your doctor or nurse about the benefits or any risks.
References
1. Munoz FM. Pertussis in infants, children, and adolescents: diagnosis, treatment, and prevention. Seminars In Pediatric Infectious Diseases. 2006;17(1):14-9.
2. Elliott E, McIntyre P, Ridley G, Morris A, Massie J, McEniery J, et al. National study of infants hospitalized with pertussis in the acellular vaccine era. The Pediatric
Infectious Disease Journal. 2004;23(3):246-52.
3. Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, et al. Whooping cough in school age children with persistent cough: prospective
cohort study in primary care. BMJ: British Medical Journal. 2006;333(7560):174-7.
4. Cherry JD. Epidemiological, Clinical, ad Laboratory Aspects of Pertussis in Adults. Clinical Infectious Diseases. 1999;28:S112.
5. Heininger U. Pertussis Immunisation in Adolescents and Adults. Hot Topics in Infection and Immunity in Children IV; 2008. p. 72-97.
6. Grant CC, Roberts M, Scragg R, Stewart J, Lennon D, Kivell D, et al. Delayed immunisation and risk of pertussis in infants: unmatched case-control study. BMJ:
British Medical Journal. 2003;326(7394):852.
7. Gonik B, Puder KS, Gonik N, Kruger M. Seroprvevalence of Bordetella pertussis antibodies in mothers and their newborn infants American Journal of Obstetrics &
Gynecology. 2003;189(6):S98-S.
8. New Zealand Immunisation Handbook 2006. Wellington: Ministry of Health.
9. Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, Mullooly JP, et al. The Risk of Seizures after Receipt of Whole-Cell Pertussis or Measles, Mumps,
and Rubella Vaccine. N Engl J Med. 2001;345(9):656-61.
10. Braun MM, Mootrey GT, Salive ME, Chen RT, Ellenberg SS, the VWG. Infant Immunization With Acellular Pertussis Vaccines in the United States: Assessment of
the First Two Years Data From the Vaccine Adverse Event Reporting System (VAERS). Pediatrics. 2000;106(4):e51.
11. McIntyre PB, Burgess MA, Egan A, Schuerman L, Hoet B. Booster vaccination of adults with reduced-antigen-content diphtheria, Tetanus and pertussis vaccine:
Immunogenicity 5 years post-vaccination. Vaccine. 2009;27(7):1062-6.
12. Campins-Mart M, Cheng HK, Forsyth K, Guiso N, Halperin S, Huang LM, et al. Recommendations are needed for adolescent and adult pertussis immunisation:
rationale and strategies for consideration. Vaccine. 2001;20(5-6):641-6.
13. Edelman K, He Q, Mkinen J, Sahlberg A, Haanper M, Schuerman L, et al. Immunity to Pertussis 5 Years after Booster Immunization during Adolescence.
Clinical Infectious Diseases. 2007;44(10):1271-7.
14. Esposito S, Agliardi T, Giammanco A, Faldella G, Cascio A, Bosis S, et al. Long-Term Pertussis-Specific Immunity after Primary Vaccination with a Combined
Diphtheria, Tetanus, Tricomponent Acellular Pertussis, and Hepatitis B Vaccine in Comparison with That after Natural Infection. Infect Immun. 2001;69(7):4516-20.
15. Le T, Cherry JA, Chang S, Knoll Maria D, Lee MartinA L, Barenkamp S, et al. Immune Responses and Antibody Decay after Immunization of Adolescents and
Adults with an Acellular Pertussis Vaccine: The APERT Study. The Journal of Infectious Diseases. 2004;190(3):535-44.
16. Versteegh FGA, Mertens PLJM, de Melker HE, Roord JJ, Schellekens JFP, Teunis PFM. Age-specific long-term course of IgG antibodies to pertussis toxin after
symptomatic infection with Bordetella pertussis. Epidemiology And Infection. 2005;133(4):737-48.
17. Elomaa A, He Q, Minh NNT, Mertsola J. Pertussis before and after the introduction of acellular pertussis vaccines in Finland. Vaccine. 2009;27(40):5443-9.
18. Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases. New
England Journal of Medicine. 2009;360(19):1981.
19. Halperin SA, Sweet L, Baxendale D, Neatby A, Rykers P, Smith B, et al. How soon after a prior tetanus-diphtheria vaccination can one give adult formulation
tetanus-diphtheria-acellular pertussis vaccine? The Pediatric Infectious Disease Journal. 2006;25(3):195-200.
TAPS No. NA 2944 DiseasePertussisImac201003V02Final